'It's been adapted rather than impacted': A qualitative evaluation of the impact of Covid-19 restrictions on the positive behavioural support of people with an intellectual disability and/or autism

How COVID-19 impacted people with disabilities: A qualitative study in Delaware

Objectives

The COVID-19 pandemic created unprecedented challenges for people with disabilities and their caregivers and service providers. An assessment of how the COVID-19 pandemic, and the public health response to it, inequitably impacted the health and well-being of people with disabilities is needed to improve preparedness for future public health emergencies. Interviews were conducted with the goal of documenting the impacts of COVID-19 on community-dwelling individuals in Delaware.

Study design

Qualitative interviews using a structured interview guide.

Methods

In November and December 2022, interviews were conducted with individuals with disabilities, their caregivers, governmental and non-profit service providers, and elected representatives in Delaware. Interviews focused on obtaining information related to COVID-related threats to maintaining good health, affordable and accessible housing, work, educational opportunities, transportation, and community belonging during the pandemic. Interview transcripts were inductively analyzed.

Results

Five themes were identified including changes to, or loss of, home-based medical and other services, changes in daily routines that impacted access to work and education, limits on access to transportation, financial strains and housing issues, and mental health concerns.

Conclusions

The COVID-19 pandemic impacted nearly all aspects of the lives of people with disabilities. COVID-19 presented long-term, existential threats to progress made toward independent living, meaningful work, and financial, health, and educational equity for people with disabilities.

An update of the reported effects of the COVID-19 pandemic on person with intellectual disability and their carers: a scoping review

BACKGROUND

The effects of the COVID-19 pandemic has been felt by all groups in society and people with intellectual disability are especially vulnerable due to underlying conditions/health problems, multi-morbidity, limitations in understanding, frailty and social circumstances. This places people with intellectual disability, their families and carers at increased risk of stress and in need of support.

OBJECTIVE

To update and chart the evidence of the effects of the COVID-19 pandemic on people with intellectual disability, their families and carers reported within the research in 2021.

METHODS

A scoping review of research published in 2021 across 7 databases.

RESULTS

84 studies met the inclusion criteria, and the findings highlight people with intellectual disability are at a greater risk to COVID-19 health outcomes due to underlying health concerns and access issues. The effects of COVID-19 can be seen from a personal, social and health perspective for people with intellectual disability, their carers and families. However, COVID-19 did have some unanticipated benefits such as: less demand on time, greater opportunity to engage with people of value and building resilience.

CONCLUSIONS

COVID-19 presents many challenges but for people with intellectual disability compounding existing obstacles encountered in access issues, service provision and supports available. There is a need to identify and describe the experiences of people with intellectual disability, their families and carers in the medium-long term during COVID-19. Greater supports and evidence of effective interventions to promote health, deliver services and support individual with intellectual disability is needed as there is little evidence of clinical care for people with intellectual disability during COVID-19.

Service delivery and programing adaptations for individuals with disabilities by municipalities and non-profit organizations during the COVID pandemic

Municipalities and nonprofit organizations play a major role in administrating services that support individuals with disabilities. The purpose of this study was to explore how these organizations responded to the COVID-19 pandemic in regards to service delivery and programming for people with disabilities. This qualitative interpretative description study used semi-structured individual interviews for data collection. Recordings of the interviews were transcribed. Then the transcripts were analyzed qualitatively for themes following an inductive approach. Twenty-six individuals working for nonprofit organization or municipalities participated in the study. Six themes were identified: doing more with less; adapting rather than creating new services; ongoing consultation with stakeholders; feeling successful at adapting the services; being innovative with fundraising and embracing radical change. Flexibility and iterative user-centered approach appeared to be common coping strategies. Remote services were privileged to adapt service delivery during the COVID-19 pandemic.

Care and rehabilitation institutions for people with intellectual disabilities during the COVID-19 pandemic: Polish experiences

People with intellectual disabilities benefit from many forms of institutional support, which include residential, rehabilitation, and educational services. Changes caused by the pandemic, especially the introduction of new rules relating to various aspects of life, raised several challenges and problems in the functioning of these institutions and for the people with disabilities during the COVID-19 pandemic. The research concerned facilities providing services for people with intellectual disabilities in Poland during the pandemic. The research goal was to determine what changes took place in the rehabilitation and care institutions during the pandemic in terms of their organization and the functioning of their clients and personnel. An online questionnaire was used. The respondents were institution employees. Data showed a number of preventive, educational, and supportive activities carried out by the institutions. Adverse changes in the psychosocial functioning of people with intellectual disabilities and other problems during the pandemic were reported.

Providing community services for persons with disabilities during the COVID-19 pandemic: A scoping review

Community organisations and municipalities support people with disabilities by providing resources and services that are essential for their engagement in the community. Their services were particularly impacted by restrictions related to the COVID-19 pandemic. The aim of the study is to identify scientific literature that examines how community organisations and municipalities adapted services and resources provided to people with disabilities as a result of the COVID-19 pandemic. A scoping review was conducted by searching the databases Medline, Embase, CINAHL, PsycINFO and Web of Science Core Collection in January 2021. Fifteen studies were included from the initial search strategy of 7651 individual studies. Most of the studies were quantitative studies (73.3%; n = 11) and aimed at describing the adaptations put in place during the COVID-19 pandemic (66.7%; n = 10). Most services and resources involved some form of preventive healthcare (66.7%; n = 10). The adaptation of modalities for delivering resources and services varied widely across organisations (e.g. online or a combination of online and in-person) but mostly led to an improvement of the studied outcome (e.g. social skills, quality of life). Barriers (e.g. need for a reliable internet connection, lack of technology literacy from the member) and facilitators (e.g. flexibility and planning from the organisations) for these adaptations have been identified, but there is little information surrounding their cost. The results highlight that the delivery of online services has increased since the inception of the COVID-19 pandemic with valuable outcomes. However, further research is needed to better identify the barriers, facilitators and outcomes of remote services to better face future large-scale disasters like the COVID-19 pandemic and to better support individuals who cannot reach in-person services.

The challenges of mental health of staff working with people with intellectual disabilities during COVID-19--A systematic review

BACKGROUND

The COVID-19 pandemic has posed a great risk to the mental health of health workers (HWs). There are likely to be particular concerns for staff working with adults with an intellectual disability, where infection control may be more challenging.

METHOD

We conducted a systematic review of original research examining the mental health of HWs working with people with intellectual disability, published between March 2020 and July 2021.

RESULTS

Five original research studies were included. A high proportion of HWs working with people with intellectual disability reported having had poor mental health including stress, anxiety, and depression. This manifested in similar patterns as for other HWs and also some specific patterns seen as the need to manage increased rates of mental health issues of the people they support. Sources of support and resilience were also identified.

CONCLUSION

The support system should target risk factors, answer unmet needs, and build resilience. More research is also required on the ongoing and long-term effects.

Neighborhood, built environment and resilience in transportation during the COVID-19 pandemic

COVID-19 has swept the world, and the unprecedented decline in transit ridership has been noticed. However, little attention has been paid to the resilience of the transportation system, particularly in medium-sized cities. Drawing upon a light rail ridership dataset in Salt Lake County from 2017 to 2021, we develop a novel method to measure the vulnerability and resilience of transit ridership using a Bayesian structure time series model. The results show that government policies have a more significant impact than the number of COVID-19 cases on transit ridership. Regarding the built environment, a highly compact urban design might reduce the building coverage ratio and makes transit stations more vulnerable and less resilient. Furthermore, the high rate of minorities is the primary reason for the drops in transit ridership. The findings are valuable for understanding the vulnerability and resilience of transit ridership to pandemics for better coping strategies in the future.

The mental health and well-being of adults with intellectual disability during the COVID-19 pandemic: A narrative review

Prior to the start of the pandemic, adults with intellectual disability (ID) were more likely to experience mental health difficulties and face barriers obtaining mental health care. COVID-related public health restrictions, combined with heightened challenges to obtain timely mental health care, have served to worsen this situation internationally, with a combination of new onset conditions and worsening mental health for those already struggling. In this narrative review, we summarize literature on the mental health of adults with ID during the COVID-19 pandemic to describe what is known based on clinician perceptions, existing administrative health data, family and staff perceptions, and self-report. In addition to noting similarities and differences in findings based on the source of information, we also explored how experiences differed depending on where and when the research was conducted. Based primarily on research conducted during the first six months of the pandemic, there is a consistent finding across sources of increased anxiety, stress, and isolation. This review also explored the delivery of virtual mental health care and the impact of pandemic-based mental health interventions. There have been very few research studies evaluating clinical care during this time but clinicians have managed to provide supports virtually, which has been evaluated positively by some individuals. This narrative review concludes by identifying gaps in the literature and suggests key directions for future mental health research, policy, and practice efforts. Any mental health efforts now and during pandemic recovery need to have an understanding of how the mental health needs and services for adults with ID have evolved over the course of the pandemic. Further research is needed on the impact of both clinical interventions and other nonclinical efforts on the mental health of people with ID.

COVID ‐19: Evolving challenges and opportunities for residential and vocational intellectual disability service providers

The sustainability of service provision continues to be a challenge in the field of intellectual disability due to changes in delivery as part of intermittent or ongoing lockdown requirements during the COVID‐19 global pandemic. There are many facets to this that may have temporary or permanent impacts not only on the sector, but ultimately for service access and outcomes for people with intellectual disability themselves. This narrative literature review identifies both opportunities for, and impacts on, service providers across jurisdictions. These are explored in terms of the effects that suspension, adaptation, continuity or the cessation of service delivery have had, and those that are projected. Such impacts include, but are not limited to, changes in service access and delivery, employment roles and responsibilities, financial sustainability and the need to diversify the services and supports provided and how they are delivered. The relevance of these impacts for family carers and people with intellectual disability is also discussed. Nonetheless, there have also been opportunities which inform the shape of service delivery and pandemic planning into the future.